肿瘤细胞减灭术联合腹腔热灌注化疗治疗腹膜癌1384例疗效分析  

Efficacy of 1384 cases of peritoneal carcinomatosis underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy

作　　者：于洋 李鑫宝 林育林 马茹 姬忠贺 张彦斌 安松林 刘刚 杨肖军[2] 李雁 Yu Yang;Li Xinbao;Lin Yulin;Ma Ru;Ji Zhonghe;Zhang Yanbin;An Songlin;Liu Gang;Yang Xiaojun;Li Yan(Department of Peritoneal Cancer Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Gastrointestinal Surgery&Peritoneal Cancer Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]首都医科大学附属北京世纪坛医院腹膜肿瘤外科,北京100038 [2]武汉大学中南医院胃肠外科/腹膜肿瘤外科,武汉430071

出　　处：《中华胃肠外科杂志》2021年第3期230-239,共10页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金面上项目(82073376);北京市医院管理局"登峰"人才培养计划(DFL20180701);北京市优秀人才培养资助集体项目(2017400003235J007)。

摘　　要：目的腹膜癌是一类原发或继发于腹膜表面的恶性肿瘤,肿瘤细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)是针对腹膜癌发展的一套综合治疗策略。本文旨在分析CRS+HIPEC治疗腹膜癌的疗效和安全性,并探讨影响其生存的预后因素。方法采用描述性病例系列研究方法,回顾性收集2004年1月至2020年1月武汉大学中南医院(330例)和首都医科大学附属北京世纪坛医院(1054例)腹膜肿瘤外科连续治疗的1384例腹膜癌患者的临床病理资料。分析本组患者CRS+HIPEC治疗情况(手术时间、器官切除数量、腹膜切除数量、吻合口数量、HIPEC方案等)、安全性[术中出血量、术后严重不良事件(SAE)及发生时间、治疗情况]、生存情况及影响生存的预后因素。SAE依照国际腹膜癌联盟不良事件定义进行分级,将Ⅲ~Ⅳ级不良事件定义为SAE。围手术期定义为CRS+HIPEC治疗日至术后30 d。OS定义为CRS+HIPEC手术当日至死亡或末次随访时间,采用Kaplan-Meier法进行生存结果描述,组间比较采用Log-rank检验。影响生存的独立预后因素则采用Cox比例风险回归模型单因素和多因素分析。结果全组患者中男529例(38.2%),中位年龄55(10~87)岁,中位体质指数为22.6 kg/m^(2)。1384例腹膜癌患者中来源于胃癌164例(11.8%),结直肠癌287例(20.7%),腹膜假黏液瘤356例(25.7%),腹膜恶性间皮瘤90例(6.5%),卵巢癌、宫颈癌、子宫内膜癌及原发性腹膜癌等共计300例(21.7%),腹膜后肉瘤、肺癌、乳腺癌等少见来源肿瘤187例(13.5%)。本组患者中位手术时间595(90~1170)min,中位脏器切除数2(0~10)个,中位腹膜切除区域数4(0~9)个,中位腹膜癌指数(PCI)评分21(1~39)分,细胞减灭程度(CC)评分0~1分达61.9%(857/1384)。HIPEC方案:顺铂+多西他赛917例(66.3%)、顺铂+丝裂霉素183例(13.2%)、阿霉素+异环磷酰胺43例(3.1%)及其他方案240例(17.3%)。331例(23.9%)腹膜癌患者发生围手术期严重不良事件500例次,�Objective Peritoneal carcinomatosis refers to a group of heterogeneous(primary or secondary)malignancies in the surface of the peritoneum.Cytoreductive surgery(CRS)plus hyperthermic intraperitoneal chemotherapy(HIPEC)is a comprehensive treatment strategy aiming at peritoneal carcinomatosis.This study analyzed the efficacy and safety of CRS+HIPEC in patients with peritoneal carcinomatosis,and explored prognostic factors.Methods In this descriptive case-series study,the clinicopathological data of 1384 consecutive patients with peritoneal carcinomatosis treated in Zhongnan Hospital of Wuhan University(330 patients)and Shijitan Hospital of Capital Medical University(1054 patients)from January 2004 to January 2020 were collected retrospectively.Treatment patterns of CRS+HIPEC characteristics(operative time,number of resected organs,number of stripped peritoneum,number of anastomosis,and HIPEC regimens),safety[blood loss volume,postoperative severe adverse event(SAE)and treatment outcome],survival time and prognostic factors influencing survival were analyzed.The SAE was defined as grade III-IV adverse event according to the Peritoneal Surface Oncology Group International Textbook.Perioperative period was defined from the day of CRS+HIPEC to postoperative 30th day.OS was calculated from the day of CRS+HIPEC to the date of death or the last follow-up.Kaplan-Meier method was used for survival analysis,and log-rank test was used for comparison between groups.Cox regression model was used to identify the prognostic factors.Results Among 1384 peritoneal carcinomatosis patients,529(38.2%)were male;median age was 55(10-87)years old;median body mass index(BMI)was 22.6 kg/m^(2);peritoneal carcinomatosis of 164(11.8%)patients were from gastric cancer,287(20.7%)from colorectal cancer,356(25.7%)from pseudomyxoma peritonei,90(6.5%)from malignant peritoneal mesothelioma,300(21.7%)from gynecological cancer or primary peritoneal carcinoma,and 187(13.5%)from retroperitoneal sarcoma,lung cancer,breast cancer,and other rare tumors.The m

关 键 词：腹膜癌 肿瘤细胞减灭术 腹腔热灌注化疗 疗效 安全性 预后 

分 类 号：R735.5[医药卫生—肿瘤]